UNKNOWN

FEED

Collaborates with internal business partners, compliance, legal, provider and payment integrity teams, and external agencies to coordinate investigative activities, support corrective actions, recoveries, and case resolution efforts. 2+ years Fraud, waste, and abuse investigations, healthcare investigations, claims audits, payment integrity, healthcare compliance, law enforcement investigations, or a related investigative field required.

YEAR

Centene Corporation Group

SIU Investigator

linkup_via_bold

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. Job Summary: The Special Investigations Unit (SIU) III is responsible for investigating and resolving high complexity allegations of healthcare fraud, waste and abuse (FWA) by medical professional, facilities, and members.

CareSource

SIU Investigator III (Must live in Arkansas)

Must be currently certified and in good standing or obtain certification within twelve (12) months of hire with one of the following: Health Care Anti-Fraud Associate (HCAFA), Accredited Health Care Fraud Investigator (AHFI), Association of Certified Fraud Examiners (CFE), or National Health Care Anti-Fraud Association (NHCAA). Responds to Requests for Information (RFIs) from National Benefit Integrity MEDIC, U.S. Office of Personnel Management Office of the Inspector General (OPM OIG), State Departments of Insurance (DOI), and other law enforcement agencies, as appropriate.

Parkland Hospital

Clinical Special Investigations Unit Investigator- Health Plan

Develop and maintain collaborative and liaison relationships with Blue Cross Blue Shield Association (BCBSA), Blue Cross Blue Shield (BCBS) Plans, HHS OIG, other carriers' anti-fraud professionals, law enforcement and regulatory agencies. May attend webinars and conferences like BCBSA, National Health Care Anti-Fraud Association (NHCAA), and Association of Certified Fraud Examiners (ACFE) to keep apprised of developments in health care fraud.

At the Blue Cross and Blue Shield Association (BCBSA), we provide business strategy, technical support and consulting expertise to 36 Blue Cross and Blue Shield companies across the nation, employing more than 1,000 of the best strategic thinkers in the industry.  We are a Brand manager that sets quality control standards for the 36 independent companies that use the Blue Cross and Blue Shield Brands, and we serve as a trade association that represents these Blue companies. It is through our involvement that the Blues companies share a united vision and strategy while also benefiting from the local strength of all member companies.

Blue Cross and Blue Shield Association

Investigator III

PART_TIME

Lemieux & Associates is seeking a part-time, on-call SIU Field Investigator in Albuquerque, NM, who is ready to put their investigative expertise to work in a rewarding role where every case presents a new challenge. With a leadership team boasting over 25 years of field experience, we are committed to unlocking the potential of our employees and creating a supportive, tight-knit community.

HOUR

Lemieux & Associates LLC

SIU Field Investigator

Talent Acquisition

FULL_TIME

You'll document findings through detailed reports, obtain written and recorded statements, conduct scene investigations, and capture photographic evidence such as accident scenes and vehicle damage. With a leadership team boasting over 25 years of field experience, we are committed to unlocking the potential of our employees and creating a supportive, tight-knit community.

Licensed SIU Field Investigator

Lemieux & Associates is seeking a part-time, on-call Bilingual SIU Field Investigator in Stamford, CT, who is ready to put their investigative expertise to work in a rewarding role where every case presents a new challenge. With a leadership team boasting over 25 years of field experience, we are committed to unlocking the potential of our employees and creating a supportive, tight-knit community.

Bilingual SIU Field Investigator

Licensed Surveillance Field Investigator

4+ years of experience as a Private Investigator, Private Detective, Licensed Investigator, Fraud Investigator, Insurance Investigator, or another closely related investigative role. Experience gathering, analyzing, and compiling information on legal, financial, or personal matters, including background checks, surveillance, interviews, and records research.

Mercor

Private Investigator - AI Evaluation

Manatal

Fraud Claims Law Specialist (FCLS) or Fraud Claims Law Associate (FCLA) designations and Certified Insurance Fraud Investigator (CIFI) or Certified Fraud Examiner (CFE) designations are preferred. Investigates files by using appropriate field, computer and telephone investigative techniques and provides appropriate documentation of actions in a thorough timely manner.

Military, Veterans and Diverse Job Seekers

ea_via_bold

Analyze insurance company and producer conduct for adherence to critical statutes, including the Insurance Trade Practices Act (Iowa Code Chapter 507B), the Insurance Producer Law (Iowa Code Chapter 522B), Licensing of Adjuster (Iowa Code Chapter 522C), Licensing of Appraisers and Umpires (Iowa Code Chapter 522F) and Uniform Securities Act (Iowa Code Chapter 502). Business management and administration including: budget administration and analysis, regulatory and legal compliance, quality assurance, and customer service administration., where thirty semester hours of accredited college or university course work in any field equals one year of full-time experience?.

State of Iowa

Investigator

Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate's degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.

Allied Universal provides unparalleled service, systems and solutions to the people and business of our communities, and is North America's leading security services provider. With over 140,000 employees, Allied Universal delivers high-quality, tailored solutions, which allows clients to focus on their core business. For more information: 866.825.5433 or <a href="http://www.aus.com/" target="_blank">www.AUS.com</a>


Allied Universal

Claims Investigator

Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance. High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud.

SIU / Claims Investigator

Surveillance / Claims Investigator Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate’s degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.

Surveillance / Claims Investigator - Part Time

[AW]-iCims

SIU Investigator - Part Time

Preferred certifications: Accredited Healthcare Fraud Investigator (AHFI), Certified Fraud Specialist (CFS), Certified Fraud Examiner (CFE), Certified Forensic Interviewer (CFI), or. Overview: As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required).

Cotiviti

Senior Investigator - Lead Validation (Healthcare FWA)

Senior Investigator (Healthcare FWA)

Claim Investigators validate the facts of loss for Insurance claims through scene Investigations, claimant and witness Interviews, document retrieval and data Interpretation. Associate’s degree in Criminal Justice with a minimum of four (4) years of demonstrated experience conducting complex insurance investigations or adjusting complex claims.

Surveillance / Claims Investigator- Part Time

Specifically, the Fraud Specialist is responsible for dispositioning alerts, positive pay payment decisions for internal bank accounts, reviewing bill payment exceptions (level 2), on-us signature verification, and escalating fraudulent activity to Fraud Case Reviewers. The Fraud Specialist I's primary objective is to review anomalous activity identified through manual processes, internal referrals, and system-generated alerts to identify suspicious check and deposit fraud activity.

Fraud Investigator Jobs in the United States

SIU Investigator Centene Corporation Group

SIU Investigator III (Must live in Arkansas) CareSource

Clinical Special Investigations Unit Investigator- Health Plan Parkland Hospital

Investigator III Blue Cross and Blue Shield Association

SIU Field Investigator Lemieux & Associates LLC

Licensed SIU Field Investigator Lemieux & Associates LLC

Bilingual SIU Field Investigator Lemieux & Associates LLC

Licensed Surveillance Field Investigator Lemieux & Associates LLC

Private Investigator - AI Evaluation Mercor

SIU Investigator Military, Veterans and Diverse Job Seekers

Investigator State of Iowa

Claims Investigator Allied Universal

SIU Investigator Allied Universal

SIU / Claims Investigator Allied Universal

Surveillance / Claims Investigator - Part Time Allied Universal

SIU Investigator - Part Time Allied Universal

Senior Investigator - Lead Validation (Healthcare FWA) Cotiviti

Senior Investigator (Healthcare FWA) Cotiviti

Surveillance / Claims Investigator- Part Time Allied Universal

Fraud Specialist I - Alert Reviewer TowneBank

Similar Job Searches

See More Jobs

Stand out to leading employers.